The policy debate on changes to the system of funding long-term care needs to look at incremental, step-by-step measures as well as radical ones
With the Dilnot Commission on Funding Care and Support poised to make its final recommendations, Ed Miliband making a ‘big, open’ offer to the government to participate in cross-party talks, and the Southern Cross debacle putting social care firmly in the minds of the public like never before, the policy debate on how we should fund older people’s long-term care is about to become very intense indeed.
From a distance, this issue looks like a very big and scary one for politicians. The debate has always tended to line up a simplistic menu of reform options of varying degrees of difficulty. The result has been a polarised political debate and a reform process seemingly frozen in perpetuity.
But it really doesn’t have to be this way. The outcomes required of long-term care funding reform represent not one reform, but many, which vary in their complexity and the political sensitivities they may inflame.
An example is the move to a national system of assessment and entitlement for public funding of care, thereby ending the current ‘postcode lottery’ that exists. Although this will represent a major upheaval for civil servants and local government, it’s arguably a fantastic ‘quick win’ for any government, for which consensus should not be so difficult to drum up. In fact, it could have been implemented years ago, and would have made it much easier to progress with other types of reform to care funding.
So in a recent report – ‘Stepping-Stones’ - the Strategic Society Centre has explored how framing different aspects of long-term care funding reform as steps in a process reveals how many of the stumbling blocks to potential reform can be overcome.
This could be about gradually extending the scope of the state-funded ‘safety net’, or the gradual move from voluntary to compulsory contributions to a new funding system, via some form of soft-compulsion.
It could mean dealing with the care funding of different cohorts at different times. It could also mean seeing different potential models of funding as steps in a process.
For example, there’s really no point in arguing over the merits or otherwise of universal free personal care if there isn’t agreement about it; far better to advance the care funding system as far as consensus will allow – perhaps to some new form of ‘partnership’ between the individual and the state – and let a future government decide in a different fiscal environment whether they want to make the state offer even more generous still.
So, in our new report, the Centre argues for a ‘stepping-stones’ strategy for reforming older people’s long-term care funding.
This emphasizes three key approaches: prioritise the implementation of those individual aspects of reform that potentially set up the implementation of multiple different funding models; evaluate different funding models as stepping-stones, not just as permanent end-points that cannot be revisited; and, proceed immediately in areas where consensus does exist.
James Lloyd is director of The Strategic Society Centre. Stepping-Stones: A strategy for reforming long-term care funding is available to download from: www.strategicsociety.org.uk
